Nightmare and Abnormal Dreams: Rare Side Effects of Metformin?

Yanto, Theo Audi; Huang, Ian; Kosasih, Felicia Nathania; Lugito, Nata Pratama Hardjo

doi:10.1155/2018/7809305

Cited by 6 publications

(5 citation statements)

References 13 publications

(17 reference statements)

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“…One study reported longer and more efficient sleep among T2D patients on metformin than those using non-metformin agents ( 5 ). In contrast, two other studies found that metformin may be associated with poor sleep quality and frequent nightmares ( 6 , 7 ). In the present study, including 11 806 patients with T2D, we found that those treated with non-metformin were more likely to report difficulty falling and staying asleep at night compared to those without antidiabetic medication use or those on metformin monotherapy.…”

Section: Discussionmentioning

confidence: 83%

“…Several factors may account for sleep difficulties among T2D patients, including but not limited to comorbidities such as overweight and hypertension (1). As suggested by previous studies, the type of oral antidiabetic agent used to prevent hyperglycemia may also account for sleep difficulties among T2D patients (5)(6)(7). For example, by using one-night sleep polysomnography, a study among 387 outpatients with T2D found that those on metformin slept on average about 36 minutes longer and exhibited a 6.4% higher sleep efficiency compared to patients on non-metformin (mainly sulfonylureas) (5).…”

Section: Introductionmentioning

confidence: 92%

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Oral Antidiabetics and Sleep Among Type 2 Diabetes Patients: Data From the UK Biobank

Xue

Tang

et al. 2021

Front. Endocrinol.

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Previous small-scale studies have found that oral antidiabetic therapy is associated with sleep difficulties among patients with type 2 diabetes (T2D). Here, we used data from 11 806 T2D patients from the UK Biobank baseline investigation to examine the association of oral antidiabetic therapy with self-reported difficulty falling and staying asleep and daily sleep duration. As shown by logistic regression adjusted for, e.g., age, T2D duration, and HbA1c, patients on non-metformin therapy (N=815; 86% were treated with sulphonylureas) had a 1.24-fold higher odds ratio of reporting regular difficulty falling and staying asleep at night compared to those without antidiabetic medication use (N=5 366, P<0.05) or those on metformin monotherapy (N=5 625, P<0.05). Non-metformin patients reported about 8 to 10 minutes longer daily sleep duration than the other groups (P<0.05). We did not find significant differences in sleep outcomes between untreated and metformin patients. Our findings suggest that non-metformin therapy may result in sleep initiation and maintenance difficulties, accompanied by a small but significant sleep extension. The results of the present study must be replicated in future studies using objective measures of sleep duration and validated questionnaires for insomnia. Considering that most T2D patients utilize multiple therapies to manage their glycemic control in the long term, it may also be worth investigating possible interactions of antidiabetic drugs on sleep.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 92%

Oral Antidiabetics and Sleep Among Type 2 Diabetes Patients: Data From the UK Biobank

Xue

Tang

et al. 2021

Front. Endocrinol.

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“…Nightmares may be caused by nocturnal hypoglycemia. However, metformin monotherapy does not produce hypoglycemia, particularly in the absence of fasting, malnutrition, vigorous exercise, and advanced age [ 8 ]. Hypoglycemia is uncommon in patients on metformin monotherapy, but Sulfonylureas carry a larger risk of hypoglycemia [ 2 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Association Between Metformin and Nightmares: A Case Report

Voloshyna¹,

Sandhu²,

Khan³

et al. 2022

Cureus

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Metformin remains the oral drug of choice for patients with type 2 diabetes mellitus (T2DM). It is an ideal anti-diabetic drug for maintaining good glycemic control in diabetics. However, the side effect profile of metformin varies from minor or no effects to substantial impact on the GI tract. In addition, metformin is rarely known for its association with nightmares. Here we present the case of a newly diagnosed 40-year-old diabetic who developed recurrent nightmares within a week of starting metformin treatment. The patient had no previous history of psychiatric or sleep disorders. However, it was the first time he had experienced such recurrent nightmares, especially after the start of 500 mg metformin thrice a day.Based on the Naranjo Adverse Drug Reaction (ADR) Probability Scale, and sudden onset and disappearance of nightmares after metformin initiation and discontinuation made metformin the primary cause of his nightmares.

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“…Besides knowledge of benefits of glycemic control, weight neutral effects and low risk of hypoglycemia, metformin use during pregnancy remains a matter of concern among physicians 26 . Previous evidence regarding the use of metformin and sleep alterations are mixed: metformin has been linked to improvement of sleep quality 27 and, conversely, was associated with insomnia and nightmares 28 . Presently, only GDM patients had poor sleep quality related to metformin therapy.…”

Section: Discussionmentioning

confidence: 99%

Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy

Façanha

Bruin

et al. 2021

Rev. Assoc. Med. Bras.

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OBJECTIVE: To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS: Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS: Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29).CONCLUSIONS: Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality.

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Nightmare and Abnormal Dreams: Rare Side Effects of Metformin?

Cited by 6 publications

References 13 publications

Oral Antidiabetics and Sleep Among Type 2 Diabetes Patients: Data From the UK Biobank

Oral Antidiabetics and Sleep Among Type 2 Diabetes Patients: Data From the UK Biobank

An Unusual Association Between Metformin and Nightmares: A Case Report

Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy

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